Case Report

Septic Discitis: An Important Cause of Back Pain

Authors: Prakashchandra Patel, MD, Kenneth E. Olive, MD, Koyamangalath Krishnan, MD

Abstract

A 65-year-old man with a 3-month history of intractable back pain had previously received cytotoxic curative chemotherapy for non-Hodgkin's lymphoma. His postchemotherapy course had been complicated by febrile neutropenia, recurrent coagulase-negative staphylococcal bacteremia, and gastrostomy site infections. He was admitted with severe intractable lower back pain requiring high doses of intravenous narcotic analgesia. Magnetic resonance imaging of the spine was highly suggestive of disk infection. Fluoroscopically guided needle aspiration of the disk space was confirmatory, and both tissue and blood cultures were positive for coagulase-negative Staphylococcus species. Treatment included IV vancomycin and oral levofloxacin. The most common organism causing disk space infection is Staphylococcus aureus, but Staphylococcus epidermis should be considered in immunocompromised patients. Septic discitis is an important differential diagnosis of back pain and should be considered in any clinical situation associated with bacteremia.

This content is limited to qualifying members.

Existing members, please login first.

If you have an existing account please login now to access this article or view your purchase options.

Purchase only this article ($15)

Create a free account, then purchase this article to download or access it online for 24 hours.

Purchase an SMJ online subscription ($75)

Create a free account, then purchase a subscription to get complete access to all articles for a full year.

Purchase a membership plan (fees vary)

Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.

References

1. Carragee EJ. Pyogenic vertebral osteomyelitis. J Bone Joint Surg Am 1997; 79: 874–880.
2. Currier BL, Eismont FJ. Infections of the spine, in Herkowitz HN, Rothman RH, Simeone FA, Balderston RA (eds): Rothman-Simeone: The Spine. Philadelphia, W.B. Saunders Co., 1992, ed 3, pp 1319–1380.
3. Neuman WR. Low back pain. IM Intern Med 2000; 21: 32–34.
4. Agency for Health Care Policy and Research. Acute Low Back Problems in Adults (Clinical Practice Guideline 14, AHCPR Pub. No. 95-0642). Rockville, MD, Agency for Health Care Policy and Research, U.S. Department of Health and Human Services, 1994.
5. McCain GA, Harth M, Bell DA, Disney TF, Austin T, Ralph E. Septic discitis. J Rheumatol 1981; 8: 100–108.
6. Waldvogel FA, Vasey H. Osteomyelitis: The past decade. N Engl J Med 1980; 303: 360–370.
7. Sapico FL, Montogomerie JZ. Pyogenic vertebral osteomyelitis: Reports of nine cases and review of literature. Rev Infect Dis 1979; 1: 754–776.
8. Modic MT, Feiglin DH, Piraino DW, Boumphrey F, Weinstein MA, Duchesneau PM, et al. Vertebral osteomyelitis: Assessment using MR. Radiology 1985; 157: 157–166.
Kemp HB, Jackson JW, Jeremiah JD, Hall AJ. Pyogenic infections occurring primarily in intervertebral discs. J Bone Joint Surg Br 1973; 55: 698–714.

I shall pass through this world but once, Any good that I can do, or any kindness That I can show to any human being, Let me do it now and not defer it. For I shall not pass this way again. - —Stephen Grellet